MEDICARE: LISA CONSTANCIO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183700000X	Pharmacy Technician

General Provider Information

NPI Number	:	1578076006
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISA CONSTANCIO

Provider Business Mailing Address
First Line	:	10621 CARMENITA RD
Second Line	:
City	:	SANTA FE SPRINGS
State	:	CA
Zip	:	90670-4017
Country	:	US
Telephone Number	:	562-298-0044
Fax Number	:

Provider Business Practice Location Address
First Line	:	10621 CARMENITA RD
Second Line	:
City	:	SANTA FE SPRINGS
State	:	CA
Zip	:	90670-4017
Country	:	US
Telephone Number	:	562-298-0044
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/06/2017
Last Update Date	:	11/06/2017

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Directions to “ LISA CONSTANCIO ” Practice Location

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